BackgroundFinancial relationships between physicians and the healthcare industry could be beneficial to improve patient care, but could lead to conflicts of interest. However, there was no study specifically evaluating the extent of financial relationships between anesthesiologists and the healthcare industry in the United States.MethodsUsing the Open Payments Database between 2014 and 2022, this longitudinal cross-sectional study examined the size, prevalence and trends of general (non-research) payments made by the healthcare industry to all anesthesiologists in the United States.ResultsOver the nine-year period, 67.0% of all anesthesiologists received general payments totaling $272.0 million over nine years, while 21.0% to 35.3% of anesthesiologists received one or more general payments each year. Median annual general payments to anesthesiologists ranged from $57 to $115. The top 1%, 5%, and 10% of anesthesiologists received 73.4%, 90.3%, and 94.8% of all general payments, respectively. There were no constant yearly trends in the total amounts and per-anesthesiologist general payments between 2014 and 2019, but significant declines occurred in 2020, likely due to the COVID-19 pandemic. Pain medicine physicians received the highest median general payments of $4,426 in nine-year combined total amounts, followed by addiction medicine ($431), critical care medicine ($277), and general anesthesiology ($256).ConclusionThis study reveals significant financial relationships between the healthcare industry and anesthesiologists, with a disproportionate concentration of payments among a minority of anesthesiologists. While no clear trends in payments were evident before the pandemic, there was a substantial reduction during the COVID-19 outbreak.